Cranial nerve deficit caused by skull metastasis of prostate cancer: three Japanese castration-resistant prostate cancer cases

Abstract

We report 3 Japanese patients with cranial nerve deficit caused by skull metastasis of prostate cancer (PCa). Case 1 was a 75-year-old patient with a chief complaint of diplopia. The cause of diplopia was right oculomotor nerve palsy from the skull metastasis. External beam radiation therapy (EBRT) to the whole brain, 40 Gy in 20 fractions, was performed and the diplopia improved. Case 2 was a 72-year-old patient with a chief complaint of facioplegia. Bone scintigraphy and computed tomography (CT) of the head revealed right occipital bone metastasis of PCa resulting in right facial nerve palsy. EBRT to the right occipital bone, 50 Gy in 25 fractions, with daily oral dexamethasone (DEX) was performed and facioplegia showed complete recovery.At 12 months after onset, the patient was followed with no symptoms. Case 3 was a 74-year-old patient with a chief complaint of diplopia. Diffusion weighted magnetic resonance imaging (MRI) and positron emission tomography (PET) showed right petrous bone metastasis resulting in right abducent nerve palsy. EBRT to the right petrous bone, 44 Gy in 22 fractions, with oral DEX was performed and diplopia showed complete recovery. At 13 months after onset, the patient was followed with no symptoms. MRI and PET may detect PCa metastasis in the skull base more clearly than other imaging modalities. EBRT with 40 -50 Gy in 20 -25 fractions in association with corticosteroid administration may be a reasonable treatment modality in the treatment of patients with metastatic PCa who develop cranial nerve dysfunction.

Isolated Oculomotor Nerve Palsy Due to Metastasis of Prostatic Cancer to the Cavernous Sinus

“…Metastatic tumour of prostatic cancer was detected in the vicinity of the cavernous sinus in all six reported cases. [1][2][3][4][5][6] In our patient, based on cranial MRI finding, metastatic tumour in the cavernous sinus might invade through the superior orbital fissure to the orbital apex and along to the orbital lateral wall. Therefore, because metastatic tumour might stimulate the lacrimal nerve on the right side, and right-sided persistent ocular pain developed.…”

“…Headache proceeded to oculomotor nerve palsy a few months. As a result, among these six reported cases, [1][2][3][4][5][6] pupillary impairment was detected in one case, 3 and pupil was spared in one case. 4 However, in four cases, 1,2,5,6 pupillary finding was not noted.…”

“…[1][2][3][4][5][6] In 1988, Svare et al 1 noted a first reported case of isolated unilateral oculomotor nerve palsy secondary to prostatic cancer. Detailed finding of oculomotor nerve palsy and accompanied symptoms were not described.…”

“…Cranial MRI demonstrated a massive lesion in the right-sided cavernous sinus. Izumi et al 5 noted a case of isolated oculomotor nerve palsy on the right side secondary to prostatic cancer. Whether there was headache or not and finding of the pupil were not mentioned.…”

Headache Caused by Brain Metastases of Castration-resistant Prostate Cancer during Cabazitaxel Therapy

“…The detailed treatment course was obtained for eight cases [11][12][13][14][15][16][17][18] in which the brain metastases were sensitive to hormonal therapy. Moreover, 23 cases (18 reports) [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] of intracranial metastasis of CRPC were identified. To clarify the characteristics of intracranial metastases of CPRC, these 23 cases are reviewed in Table 1.…”